Schizophrenia in Adults

A person with schizophrenia typically experiences changes in behaviour and perception, and disordered thinking that can distort their sense of reality. Schizophrenia is a mental illness with much stigma and misinformation associated with it. This often increases the distress to the person and his/her family. Schizophrenia usually first appears when people are aged between 15 and 25 years, although it can appear later in life. The prevalence of schizophrenia is about one percent in the general population.

Symptoms

The major symptoms of schizophrenia include:

Delusions – false beliefs of persecution, guilt or grandeur, or being under outside control. People with schizophrenia may describe plots against them or think they have special gifts and powers. Sometimes they withdraw from people or hide to avoid imagined persecution.

Hallucinations – most commonly involve hearing voices. Other less common experiences can include seeing, feeling, tasting or smelling things that to the person are very real, but that are not actually there.

Thought disorder – where speech may be difficult to follow with no logical connection. Thoughts and speech may be jumbled and disjointed.

Lack of drive – where the ability to engage in everyday activities, such as washing and cooking, is lost. This lack of drive, motivation and initiative is part of the illness, and is not laziness.

Thinking difficulties – a person’s concentration, memory, and ability to plan and organise may be affected. This makes it more difficult to reason, communicate, and complete daily tasks.

Blunted expression of emotions – where the ability to express emotion is greatly reduced. This is often accompanied by an inappropriate response to happy or sad occasions.

Social withdrawal – this may be caused by a number of factors including the fear that someone is going to harm them, or a fear of interacting with other people because of a loss of social skills.

Lack of insight – because some experiences, such as delusions and hallucinations, are so real, it is common for people with schizophrenia to be unaware that they are ill. This can be very distressing for family and carers. Lack of awareness can be a reason that people with schizophrenia refuse to accept treatment that could be helpful. The unwanted side-effects of some medications can also contribute to treatment refusal.

What causes schizophrenia?

No single cause of schizophrenia has been identified, but several factors have been shown to be associated with its onset. Men and women have an equal chance of developing this mental illness across the lifespan, although the onset for men is often earlier.

Genetic factors: A predisposition to schizophrenia can run in families. In the general population, only one percent of people develop it over their lifetime, but if one parent has schizophrenia, the children have a 10 percent chance of developing the condition – and a 90 percent chance of not developing it.

Biochemical factors: Certain biochemical substances in the brain are believed to be involved in schizophrenia, especially a neurotransmitter called dopamine. One likely cause of this chemical imbalance is the person’s genetic predisposition to the illness. Complications during pregnancy or birth that cause structural damage to the brain may also be involved.

Family relationships: No evidence has been found to support the suggestion that family relationships cause the illness. However, some people with schizophrenia are sensitive to any family tension, which for them may be associated with recurrent episodes.

Stress: It is well recognised that stressful incidents often precede the onset of schizophrenia. These may act as precipitating events in vulnerable people. People with schizophrenia often become anxious, irritable and unable to concentrate before any acute symptoms are evident. This can cause problems with work or study and relationships to deteriorate. Often these factors are then blamed for the onset of the illness when, in fact, the illness itself has caused the stressful event. It is not, therefore, always clear whether stress is a cause or a result of schizophrenia

Alcohol and other drug use: Harmful alcohol and other drug use, particularly cannabis and amphetamine use, may trigger psychosis in people who are vulnerable to developing schizophrenia. While substance use does not cause schizophrenia, it is strongly related to relapse.

What treatment is available?

The most effective treatment for schizophrenia involves medication, psychological therapy and support with managing its impact on everyday life. Education about the illness and learning to respond effectively to the early warning signs of an episode are important.